Apr 18 Supporting despair

This post perhaps isn’t going to be one of my most coherent or articulate but I need to write. I have just come back from the meeting with my consultant and person in charge of psychological therapeutic input in my community. It did not go as I had hoped and I am currently left wondering just what I am supposed to do when the MH team who are meant to be supporting me have actually sent me into a state of despair and hopelessness.

There are so many things that were said that made me angry. Firstly, even if they wanted to, the psychological therapies department can’t offer me any psychotherapy (psycho -analytic, -dynamic or the like) because the county doesn’t provide it as an option. Why? Because apparently it’s not evidence based as being successful. The CCG have decided in their wisdom that solution based therapies such as CBT and DBT are much more effective and therefore are all that is offered. I know I can’t get angry at my team for this being the case but I am angry nonetheless. I am the person who matters to me and I have shed loads of evidence that psychotherapy works for me. Before my admission to the therapeutic community where I received 9 months of intensive psychotherapy I was on a Section in an acute ward, wanting, and trying, to kill myself. Now, I have been out in my community on my own for a month, am engaging and functioning in society, have plans for the future that I really want to see happen and haven’t self harmed in months. The psychoanalytic psychotherapy I received worked in a way that no solution focused therapies ever have. Why doesn’t that count as evidence??

Secondly, the team won’t accept me for ANY therapeutic input currently because it is too close to my therapy at the Cassel ending. I accept this - I know that there has to be a decent break between therapies ending and new ones starting and I was prepared for them to say so. However, I am not happy that they wouldn’t give me any kind of time frame as to how long a gap would be necessary. Apparently they’ll just know when the time is right. That is absolutely useless for someone like me, who interestingly but not necessarily demonstratively also has a diagnosis of Obsessive-Compulsive personality disorder and can’t deal with the unknown. I argued that having something to aim for and know was in place in the future would help stabilise me in the here and now and motivate me to stay positive, focused and engaged in reintegrating back into society but that was met with the suggestion that then I would just be “sitting on my hands” for the length of time that it took for me to get there. That infuriated me because it insinuates that I would be manipulating things to get the therapy rather than just getting there in my own time.

Thirdly, no one would talk about what kind of therapy they could offer me when the magical wait is over. They said they didn’t want to offer me solution focused stuff like CBT and they weren’t happy that counseling would be the answer but they didn’t tell me what they do have that could help, even when I asked explicitly. Again, totally unhelpful for my way of thinking.

Ultimately then, that leaves me at the situation I am in now. Seeing my care coordinator for one hour every fortnight. The rest is down to me. To manage my mental health on my own. It just makes no sense to me. I was deemed unwell enough to have spent the last 18months of my life in hospitals of one kind or another and now that I have been discharged (notably because the admission was a pre-determined length not because I was deemed better enough) I am suddenly expected to manage everything by myself. How does that work?? I am in exactly the same position now as I was before the hospital admissions began, with exceptionally sparse support that was not adequate then and isn’t adequate now. I tried making this point several times but just ended up crying. The response I got was that I’m not on my own - I have my care coordinator and I have the employment specialist who is there to help me find meaningful activity to fill my time with but who I won’t see on any regular basis and isn’t there to offer emotional support anyway. Oh, and I have ad hoc, generally quarterly, medical reviews with my psychiatrist. “So that’s not nothing is it?” It feels to me like it may as well be. What’s worse is my feeling of invalidation and the worry that it is my stupid diagnosis that makes people tell me I have to take responsibility for getting myself better. If I knew how to do that don’t they think I would have done it by now? People with bipolar and schizophrenia, as two random examples, wouldn’t get told to go away and manage themselves so why does bpd lead to that?

Now I feel guilty. I know that my team want the best for me and are limited in what they can offer and I do trust them, I think. Also, my reactions are probably the way they are due to my conditions themselves. However, I think there are major issues that need addressing in the wider arena that lead people to end up in positions like mine and that is what I want to change.

I am going to do this, complete this indeterminate period of time, manage with the little support I do have. I am going to do it because I want something different from my life. I don’t want to be swallowed up into the same cycle that life has been before and go nowhere. I will keep fighting to get better and better and keep moving forward.